MEDICARE: RACHEL L TERRELL-BOODRAM LPC NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	14042	CA
2	101YP2500X	Professional Counselor	011234	GA

General Provider Information

NPI Number	:	1013341205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL L TERRELL-BOODRAM LPC NCC

Provider Business Mailing Address
First Line	:	799 HAMMOND DR UNIT 125
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30328-5593
Country	:	US
Telephone Number	:	678-663-3477
Fax Number	:

Provider Business Practice Location Address
First Line	:	799 HAMMOND DR UNIT 125
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30328-5593
Country	:	US
Telephone Number	:	678-663-3477
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2013
Last Update Date	:	04/24/2026

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